Perioperative use of fentanyl and tramadol in pediatric distal humerus fractures: a 15-year retrospective cohort study in Korea

Longitudinal data on perioperative opioid use for pediatric orthopedic fractures are sparse. This study evaluated 15-year trends in perioperative opioid use for pediatric distal humerus fractures in Korea. Population-based medical data from 51,638,809 subscribers to the Health Insurance Review and Assessment Service were analyzed to assess perioperative opioid use patterns. We reviewed patients aged 2-12 years who underwent closed reduction and percutaneous pinning between 2007 and 2021. A total of 33,770 cases were identified, including 17,945 cases of perioperative opioid use. Injectable opioids were administered in 17,665 cases, and oral opioids were administered in 642 cases. The two most commonly used opioids were injectable fentanyl (60.7%) and injectable tramadol (36.8%). The percentage of total opioid use increased from 40.7% in 2007 to 63.5% in 2018. While the use of injectable fentanyl has steadily increased, the use of injectable tramadol has decreased since 2017. More than half of the pediatric patients who underwent surgery for distal humerus fractures received opioids during the perioperative period. Most commonly used opioid was injectable fentanyl, and its usage continued to increase, representing almost all opioids used in surgeries by 2021. Further research is necessary to analyze the effect of this trend change in injectable fentanyl and tramadol use, offering with recommendations for reducing opioids.